Incidence of atrial flutter and atrial fibrillation in patients with implanted physiological pacemakers

Atrial flutter (AF) is a troublesome arrhythmia for patients with an implan ted pacemaker. Although it has recently become possible to eliminate AF by radiofrequency catheter ablation (RF-CA), the incidence of AF before and af ter pacemaker implantation has not been clarified. The present study was co nducted with 123 consecutive patients (69.3 +/- 11.6 (SD) years old) implan ted with pacemakers, excluding patients who had chronic atrial fibrillation (AFib) when the pacemaker was implanted; 69 patients with atrioventricular (AV) block and 54 patients with sick sinus syndrome (including 29 patients with bradycardia-tachycardia syndrome). All patients were implanted with p hysiological pacemakers. The follow-up period was 4.7 +/- 1.9 years. In 11 of the 123 patients (8.9%), AF was observed before pacemaker implantation a nd the incidence was significantly higher in patients with sick sinus syndr ome than in those with AV block (16.7 vs 2.9%, p < 0.01). Nine of the 29 pa tients with bradycardia-tachycardia syndrome (31%) had AF. After physiologi cal pacemaker implantation, AF recurred in 9 of the 11 patients, and AF was newly observed in 1 patient. Thus, 10 of the 123 patients (8.1%) had AF af ter physiological pacemaker implantation. Recurrence of AF was not suppress ed by physiological pacing. Thirty of the 123 patients had AFib before impl antation of a pacemaker and its occurrence was reduced by physiological pac ing (from 24.4% to 12.2%, p < 0.05). The incidence of AFib in patients with AF was significantly higher than in those without AF (90.0 vs 5.3%, p < 0. 001). In conclusion, the recurrence of AF is not prevented by physiological pacing and is closely related to the occurrence of AFib. RF-CA should be c onsidered in patients who have AF before pacemaker implantation.